[Tracheotomy or intubation, alternatives in the treatment of respiratory insufficiency during infectious diseases in childhood].

Resumen:

Tracheostomy and endotracheal intubation are complementary methods in the management of acute respiratory failure (ARF). One hundred patients (n = 100) were treated at the Intensive Care Unit for Infants and Children, University Hospital of Infectious Diseases "Dr. Fran Mihaljevic" Zagreb, from 1987 to 1991. They mostly suffered from severe infectious diseases in the course of which ARF developed. Endotracheal intubation was performed in 95/100 patients, while tracheostomy was done in 11/100 patients. In the majority of subjects the course of the disease required mechanical ventilation (96%). Complications connected with tracheostomy or intubation developed in 49% of the intubated patients and in 100% of the patients with tracheostomy. 17% mortality rate among our patients was neither the result of tracheostomy or intubation nor of the respiratory support but of the adverse course of the disease and consecutive complications characteristic for newborns and infants. Most of our patients developed ARF as a result of inefficient gas transfer, particularly those suffering from central nervous system infection. Nasotracheal intubation appeared to be the method of choice in the treatment of ARF in infancy and childhood, while tracheostomy is only the supplement of substitute when particular indications are present. In most of our patients (83%) those methods contributed to the positive outcome of ARF treatment.